Module 9 Exam|100 Questions With
verified Answers
A client who has undergone abdominal surgery calls the nurse and reports that she just
felt "something give way" in the abdominal incision. The nurse checks the incision and
notes the presence of wound dehiscence. The nurse immediately takes which action? -
Correct AnswerCovers the abdominal wound with a sterile dressing moistened with
sterile saline solution
A client who just returned from the recovery room after a tonsillectomy and
adenoidectomy is restless and her pulse rate is increased. As the nurse continues the
assessment, the client begins to vomit a copious amount of bright-red blood. Which is
the immediate nursing action? - Correct AnswerNotify the surgeon
A client who has just undergone surgery suddenly experiences chest pain, dyspnea,
and tachypnea. The nurse suspects that the client has a pulmonary embolism and
immediately takes which action? - Correct AnswerAdministering oxygen by way of
nasal cannula
A nurse is assessing a client who has a closed chest tube drainage system. The nurse
notes constant bubbling in the water seal chamber. What actions should the nurse
take? Select all that apply. - Correct AnswerAssessing the system for an external air
leak
Documenting assessment findings, actions taken, and client response
A nurse is helping a client with a closed chest tube drainage system get out of bed and
into a chair. During the transfer, the chest tube is caught on the leg of the chair and
dislodged from the insertion site. The immediate priority on the part of the nurse is
which action? - Correct AnswerCovering the insertion site with a sterile occlusive
dressing
A nurse performing nasopharyngeal suctioning and suddenly notes the presence of
bloody secretions. The nurse should take which action first? - Correct AnswerCheck
the degree of suction being applied.
A nurse is suctioning a client through a tracheostomy tube. During the procedure, the
client begins to cough, and the nurse hears a wheeze. The nurse tries to remove the
suction catheter from the client's trachea but is unable to do so. The nurse would take
which action first? - Correct AnswerDisconnect the suction source from the catheter.
A nurse assesses the closed chest tube drainage system of a client who underwent
lobectomy 24 hours ago. The nurse notes that there has been no chest tube drainage
, for the past hour. The nurse first performs which action? - Correct AnswerChecks for
kinks in the drainage system
A nurse is monitoring a postoperative client on an hourly basis. The nurse notes that the
client's urine output for the past hour was 25 mL. On the basis of this finding, the nurse
takes which action first? - Correct AnswerChecks the client's overall intake and output
record
A nurse is getting a client out of bed for the first time since surgery. The nurse raises the
head of the bed, and the client complains of dizziness. Which action should the nurse
take first? - Correct AnswerLowering the head of the bed slowly until the dizziness is
relieved
A nurse is preparing for intershift report when a nurse's aide pulls an emergency call
light in a client's room. Upon Answering the light, the nurse finds a client who returned
from surgery earlier in the day experiencing tachycardia and tachypnea. Which action
should the nurse take first? - Correct AnswerAdministering oxygen at the prescribed
rate
A nurse is monitoring the chest tube drainage system of a postoperative client who has
undergone a right upper lobectomy. The closed drainage system contains 300 mL of
bloody drainage, and the nurse notes intermittent bubbling in the water seal chamber.
One hour after the initial assessment, the nurse notes that the bubbling in the water seal
chamber is now constant, and the client appears dyspneic. On the basis of these
findings, the nurse should assist with data collection by examining which aspect first? -
Correct AnswerThe chest tube connections
A client recovering from surgery has a large abdominal wound. Which of the following
foods, high in vitamin C, should the nurse encourage the client to eat as a means of
promoting wound healing? - Correct AnswerOranges
A nurse is caring for a client who has just regained bowel sounds after undergoing
surgery. The health care provider has prescribed a clear liquid diet for the client. Which
of the following items does the nurse ensure is available in the client's room before
allowing the client to drink? - Correct AnswerSuction equipment
A client in the postanesthesia care unit has an as-needed prescription for ondansetron.
Which occurrence would prompt the nurse to administer this medication to the client? -
Correct AnswerNausea and vomiting
A nurse administers scopolamine as prescribed to a client in preparation for surgery.
For which side effect of this medication does the nurse monitor the client? - Correct
AnswerComplaints of dry mouth
verified Answers
A client who has undergone abdominal surgery calls the nurse and reports that she just
felt "something give way" in the abdominal incision. The nurse checks the incision and
notes the presence of wound dehiscence. The nurse immediately takes which action? -
Correct AnswerCovers the abdominal wound with a sterile dressing moistened with
sterile saline solution
A client who just returned from the recovery room after a tonsillectomy and
adenoidectomy is restless and her pulse rate is increased. As the nurse continues the
assessment, the client begins to vomit a copious amount of bright-red blood. Which is
the immediate nursing action? - Correct AnswerNotify the surgeon
A client who has just undergone surgery suddenly experiences chest pain, dyspnea,
and tachypnea. The nurse suspects that the client has a pulmonary embolism and
immediately takes which action? - Correct AnswerAdministering oxygen by way of
nasal cannula
A nurse is assessing a client who has a closed chest tube drainage system. The nurse
notes constant bubbling in the water seal chamber. What actions should the nurse
take? Select all that apply. - Correct AnswerAssessing the system for an external air
leak
Documenting assessment findings, actions taken, and client response
A nurse is helping a client with a closed chest tube drainage system get out of bed and
into a chair. During the transfer, the chest tube is caught on the leg of the chair and
dislodged from the insertion site. The immediate priority on the part of the nurse is
which action? - Correct AnswerCovering the insertion site with a sterile occlusive
dressing
A nurse performing nasopharyngeal suctioning and suddenly notes the presence of
bloody secretions. The nurse should take which action first? - Correct AnswerCheck
the degree of suction being applied.
A nurse is suctioning a client through a tracheostomy tube. During the procedure, the
client begins to cough, and the nurse hears a wheeze. The nurse tries to remove the
suction catheter from the client's trachea but is unable to do so. The nurse would take
which action first? - Correct AnswerDisconnect the suction source from the catheter.
A nurse assesses the closed chest tube drainage system of a client who underwent
lobectomy 24 hours ago. The nurse notes that there has been no chest tube drainage
, for the past hour. The nurse first performs which action? - Correct AnswerChecks for
kinks in the drainage system
A nurse is monitoring a postoperative client on an hourly basis. The nurse notes that the
client's urine output for the past hour was 25 mL. On the basis of this finding, the nurse
takes which action first? - Correct AnswerChecks the client's overall intake and output
record
A nurse is getting a client out of bed for the first time since surgery. The nurse raises the
head of the bed, and the client complains of dizziness. Which action should the nurse
take first? - Correct AnswerLowering the head of the bed slowly until the dizziness is
relieved
A nurse is preparing for intershift report when a nurse's aide pulls an emergency call
light in a client's room. Upon Answering the light, the nurse finds a client who returned
from surgery earlier in the day experiencing tachycardia and tachypnea. Which action
should the nurse take first? - Correct AnswerAdministering oxygen at the prescribed
rate
A nurse is monitoring the chest tube drainage system of a postoperative client who has
undergone a right upper lobectomy. The closed drainage system contains 300 mL of
bloody drainage, and the nurse notes intermittent bubbling in the water seal chamber.
One hour after the initial assessment, the nurse notes that the bubbling in the water seal
chamber is now constant, and the client appears dyspneic. On the basis of these
findings, the nurse should assist with data collection by examining which aspect first? -
Correct AnswerThe chest tube connections
A client recovering from surgery has a large abdominal wound. Which of the following
foods, high in vitamin C, should the nurse encourage the client to eat as a means of
promoting wound healing? - Correct AnswerOranges
A nurse is caring for a client who has just regained bowel sounds after undergoing
surgery. The health care provider has prescribed a clear liquid diet for the client. Which
of the following items does the nurse ensure is available in the client's room before
allowing the client to drink? - Correct AnswerSuction equipment
A client in the postanesthesia care unit has an as-needed prescription for ondansetron.
Which occurrence would prompt the nurse to administer this medication to the client? -
Correct AnswerNausea and vomiting
A nurse administers scopolamine as prescribed to a client in preparation for surgery.
For which side effect of this medication does the nurse monitor the client? - Correct
AnswerComplaints of dry mouth
